What are three absolute contraindications to HVLA?

• A. Acute fracture in the treated region; suspected vertebral artery insufficiency; severe osteoporosis or ligamentous instability
• B. Mild sprain; dehydration; recent minor surgery
• C. Osteoarthritis; mild scoliosis; age under 18
• D. Chronic low back pain; obesity; smoking

Answer: (A)

Absolute contraindications to HVLA are conditions that make a high-velocity thrust unsafe due to the high risk of causing more harm. The three key ones are an acute fracture in the region to be treated, suspected vertebral artery insufficiency, and severe osteoporosis or ligamentous instability. An acute fracture means the bone hasn’t had time to heal and a thrust could worsen the break or displace fragments. Suspected vertebral artery insufficiency dramatically raises the risk of a stroke if the cervical vertebrae are manipulated. Severe osteoporosis or ligamentous instability means the bones or supporting structures can’t tolerate the forces of HVLA, making fractures, dislocations, or neural injury likely. Other conditions listed—such as mild sprains, dehydration, recent minor surgery, osteoarthritis, mild scoliosis, age under 18, chronic low back pain, obesity, or smoking—may require caution or modification but are not absolute turn-aways from HVLA.